Patients waiting outside a PIH/ZL clinic in central Haiti.

Within weeks of the earthquake on January 12, 2010, the Haitian Ministry of Health’s national HIV program went to work ensuring that thousands of patients living with HIV continued to receive medications and care. Supported by two of Haiti’s largest HIV care providers – Partners In Health/Zanmi Lasante and GHESKIO – the program was able to quickly account for more than 95 percent of existing HIV patients. In many instances, investments that had been made in the HIV program provided a platform to respond rapidly to the needs of mass casualties after the disaster.

This feat was not the product of chance or luck, but the result of a decade-long initiative aimed at expanding and integrating HIV services into existing health systems.

“[T]he lesson is simple,” writes Dr. Louise Ivers, PIH’s Senior Health and Policy Advisor, in her recent editorial in the American Journal of Public Health. “[A] program with sufficient human resources, a functional medical records system (with electronic back-up), and a working coordination mechanism pre-earthquake was able to recuperate rapidly and to work on implementing a plan for its own needs going forward.”

Haiti’s largest and most successful national HIV programs have long focused on system-wide health care strengthening.

“[H]ealth care programs can and should be made with the system as a whole in mind, carefully constructed within the context of national plans and avoiding the errors of vertical projects,” writes Dr. Ivers. “In this way, a program created to respond to one crisis (HIV) has the breadth and flexibility and substance with which to respond to a totally different kind of crisis (mass casualties).”

Integrated care results in healthy patients.

In the early 2000s, with support from the Global Fund for AIDS, Tuberculosis, and Malaria and later from the President’s Emergency Fund for AIDS Relief (PEPFAR), PIH/ZL collaborated with the national HIV program to significantly bolster services and programs by intertwining health programs and developing an electronic patient record system.

The effects were immediate and substantial.

“In PIH-supported programs…pediatric consultations [between 1998 and 2008] increased by more than 500 percent after Global Fund and PEPFAR funding began, as did the number of pregnant women seeking services,” writes Dr. Ivers. “This increase was compared with an average 1 percent increase for pediatrics and 56 percent increase for pregnant women seeking services at a large general hospital also with Global Fund and PEPFAR funding over a similar timeframe.”

These lessons can serve as a guide to other health organizations working in developing countries.

“[H]ealth programs that were successful before the disaster provided both a platform from which to respond [to both the injured and people living with HIV] and a lesson on how to strengthen the country’s health system,” writes Dr. Ivers. “The opportunity now for Haiti in the context of so much interest and funding and so many organizations involved is for us all to put our shoulders together to create a health system that is greater than the sum of its potentially disparate parts.” 

Dr. Ivers’s editorial, “Strengthening the Health System While Investing in Haiti,” can be found in the June 2011 edition of the American Journal of Public Health

 

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